Reform an empty word without public option

Written by David Morse

October 09, 2009

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I have to confess that the need for healthcare reform didn’t fully hit me until I was hospitalized last March for emergency removal of 18 inches of small intestine that somehow got twisted and gangrenous.

I was lucky. I was visiting my son in Vermont when I experienced stomach pain and nausea, and was taken by ambulance to one of New England’s top-notch hospitals. Had I been traveling in war-torn South Sudan, with its nonexistent medical facilities, and “roads” that become a sea of red mud during the rainy season, I would not be alive to write these words.

Oddly, though, the image that kept coming to mind as I lay in the ICU, attached to various life-support systems and attended by a bevy of highly trained personnel—surgeons, anesthesiologists, pulmonologists, nurses—was something I saw two years earlier in the market town of Akon, in South Sudan.

A woman was being carried down the road in a bed. Four men, each toting a leg of the bed—constructed of rough-cut wood and a lattice of rope—were slogging through the mud in 105-degree heat with such determination that it was all I could do to catch up. When I finally did, I learned that they’d carried her like that for two hours to get to a clinic that consisted of a big shade tree and a meager stash of medicines—on the chance that someone could save her.

Gaunt and feverish, she told her story in Dinka and someone translated. She had gone into labor, and after two days of contractions, the traditional midwife decided the birth canal was too narrow, cut up the baby, and withdrew the pieces vaginally. Perhaps something was left in her uterus. Perhaps she’d been cut.

Soon we were joined by my Dinka colleague, Chris Koor Garang, a trained nurse who had brought medicines. He gave her an oral antibiotic and instructions for taking the remaining doses.

We later learned she lived.

For me that woman has become an emblem of survival. I’m grateful for the technology that saved my own life. But my point here is not to contrast a failed or nonexistent healthcare delivery system with a successful one. On the contrary, that woman and I both represent failed systems. They have simply failed in different ways—the one from poverty, the other from profits.

My treatment was commodified in ways that hers were not. The total price tag for my surgery and related expenses came to $144,000. That’s $8,000 for every inch of intestine removed.

Fortunately my costs were covered by Medicare, supplemented by the excellent private healthcare insurance that my wife gets as a retired University of Connecticut professor. I was out hardly a dime.

My son in Vermont has no such coverage. He works as a chef and is one of the 40 million uninsured. Like most Americans, he is in debt. Too young for Medicare, and struggling to make ends meet, he lost his private healthcare coverage last June by failing to make a monthly payment on time.

Others among our fellow citizens are denied coverage by private insurers because they are sick. Cancer, diabetes, or heart conditions make them “poor risks” for profit-driven companies. Still others have coverage tied to their employment, marital status, parents, or tuition payments. And finally, there are those too poor to do more than put food on the table. In other words, it’s a completely insane system.

Is this any less bizarre than that woman being carried down the road by her extended family to a clinic that barely exists?

I think not. We have shaped our technology, or allowed it to shape us, into a system which at its very essence is less humane than one ravaged by decades of colonialism followed by decades of war.

This is why a “public option” should be central to any healthcare reform. It offers an alternative for the uninsured, while serving as a yardstick to measure the performance of an industry notorious for its greed and runaway costs. “Reform” without a public option would simply be a gift to that industry.

David Morse is a Connecticut-based journalist whose work focuses on Sudan.